Community Partner Perspectives on Implementation Determinants of a Strengths-Based, Trauma-Informed School Suicide Prevention Intervention

Background Research has revealed persistent disparities in meeting the needs of racially minoritized youth identified with suicide risk in schools. An evidence-based trauma-informed suicide prevention practice, such as SAFETY-A (Safe Alternatives for Teens and Youth-Acute), may reduce unmet need and promote equitable care outcomes. Yet, it is highly challenging to implement practice innovations in under-resourced non-specialty settings, such as schools. Method We conducted a multi-level assessment of barriers to implementing SAFETY-A in school districts serving predominantly immigrant families of color. School-based providers ( N = 17) and caregivers and students ( N = 10) were interviewed about their perceptions of the feasibility and acceptability of SAFETY-A within their school and community context. Immersion and crystallization analytical methods were used to identify implementation barriers that align with the Health Equity Implementation Framework (HEIF). Results Eleven themes were identified across multiple determinant levels. Findings show that implementation barriers are interrelated across determinant levels. Major barriers were related to the lack of resources in schools; the historical context of system over-involvement with communities of color that contribute to (l)earned mistrust; and cultural and linguistic differences working with families. Conclusions Results aligned with HEIF domains implicated in maintaining health disparities. Implementation strategies for SAFETY-A in schools should be responsive to these determinants of disparities.